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Last Minute Oral Boards > Random Info > Flashcards

Random Info Flashcards

1
Q

BL Adrenal Hyperplasia

A

Mitotante

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2
Q

Aldosterenoma (Conn) Labs

A

Hypokalemia
A:R&raquo_space;20

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3
Q

When to do colectomy UC

A

First sign of dysplasia - usually 10 years after diagnosis

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4
Q

How to Stage Gastric CA

A

EGD BX
CT CAP / PET
Endoscopic US for staging if no mets

Most will get neoadjuvant chemo – repeat staging after this

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5
Q

BX for GIST - what do you see

A

Spindle cells, CD 117, CKIT+

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6
Q

Adjuvant for GIST

A

Imatinib - TK inhibitor – target Exon 9 / 11 (if 9, need higher dosing)

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7
Q

Hx for Gastric Stff

A

Smoking, PPI, fam / personal CA, prior scope, prior h pylori treatment

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8
Q

Imaging workup for suspicious GB

A

CT CAP and MRCP to better eval US findings

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9
Q

Critical View of Safety

A

Cystic duct, GB inferior border and common hepatic duct cleared of tissue
Must see cystic plate / liver bed in fossa with only 2 structures entering the GB

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10
Q

UC screening

A

Screen 8 years after UC diagnosis
C-Scope annually with circumferential bx every 10 cm for 33 bx

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11
Q

Adenomatous polyp screen

A

Repeat at 3 years if 3+ or over 1cm

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12
Q

What if you can’t do full scope in colon ca

A

CT colonography or enemagram

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13
Q

Lynch - when to scope and remove colon

A

Scope at 25 and annual, EGD 35
Recommend total proctocolectomy

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14
Q

Tumors assoc with FAP

A

Thyroid, desmoid, brain, colon, epidermal cyst

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15
Q

When to consider transanal rectal excision

A

Under 3 cm, under 1/3 circumference
Under 8 cm from verge
Mobile
Can get 3mm margin
No lymphovascular or perineural invasion

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16
Q

T 2 Rectal CA

A

Can do upfront surgery with LAR or APR
T3 invasion of perirectal tissue, needs neoadjuvant chemoradition therapy
If preop LN dx - preoperative XRT

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17
Q

when to do neoadjuvant xrt in rectal ca

A

T beyond muscularis or nodes
then re-stage prior to LAR or APR

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18
Q

Medical therapy - anal fissure
And if that doesn’t work?

A

Hydrate, fiber, topical nitro / lido / nifedipine
Then botox to internal sphincter
Then lateral internal sphincterotomy

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19
Q

Follow up for appendiceal NET

A

If over 2 cm, incomplete resection, mets or goblet
Serial plasma chromogranin A, CT CAP

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20
Q

What to assess in acute IBD flare
What must you rule out

A

HD stability
weight loss
anemia
nutrition
duration of steroid / biologic tx
Rule out cdiff / cmv

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21
Q

Neoadjuvant Chemo for Esoph
What are the next steps?

A

CROSS - Carboplatin, paclitaxel, radiation
Repeat labs (nutrition), EGD w/ EUS / BX and PET CT / CAP w/ Contrast

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22
Q

Test for Esoph Perf, and what order do they go?

A
  1. CXR
  2. Esophagram with gastrograffin
  3. thin barium

** no gastrograffin for high aspiration risk

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23
Q

Post op care after intervention for bleeding gastric ulcer

A

ICU, serial HH, PPI, Coags

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24
Q

What med can slow down ECF output

A

Octreotide

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25
Q

What contrast for woods lamp?
Spy?

A

Woods lamp – Flourescene
Spy - ICG

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26
Q

Plan for colon ca in setting of Lynch syndrome and mismatch genes

A

If Lynch – total abdominal colectomy

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27
Q

What if woman with Lynch

A

TAC and hysterectomy/oopherectomy

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28
Q

What to do on c scope for acute flare of IBD

A

Ruel out infectious
Do bx for CMV

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29
Q

1st Line Medical mgmt of severe UC
What do you monitor

A

IV steroid - monitor bm frequency, bleeding, wbc and crp

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30
Q

What if no response to initial steroids in severe IBD flare

A

Start infliximab and reasses in 5-7 days with repeat endoscopy

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31
Q

What if no response to steroid / infliximab?

A

Surgery

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32
Q

Indications for surgery in UC

A

Toxic megacolon
Perforation
Fx medical management
Dysplasia / Cancer

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33
Q

Tx for high output ileostomy

A

Aim for under 1.2 L
Silium
Fiber
Loperamide (2 tabs / 4x daily)
Then lomotil
Then: Somatostatin, oral coating, tincture of opium

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34
Q

What to say when ordering CT w/ IV

A

If Cr normal on my labs, i would get a CT with iv contrast

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35
Q

Bleeding GI patient - what labs?

A

CBC, Coags, T/S, Lactic

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36
Q

C scope timing for bleeding

A

Admit, resuscitate and give blood for 24 hours
Trend h/h
Perform C-scope following bowel prep

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37
Q

When to scope after diverticulitis

A

8-12 weeks following episode, perform c-scope to rule out CA

38
Q

What tests for female with lower abdominal pain

A

HCG, UA, transvaginal US – plus all usual suspects

39
Q

Hemangiom

A

Nodular peripheral/centripetal enhancement

40
Q

FNH

A

Central scar

41
Q

HCC

A

Hypervascular pattern with arterial enhancement and RAPID washout on PV phase

42
Q

Adenoma

A

Hyperascular on arterial phase

43
Q

Liver met

A

Hypodense lesion

44
Q

What extra tests for any anal scc

A

HPV / HIV

45
Q

Atypical Causes of Fissure

A

HIV, syphillis, Crohn’s or Neoplasm

46
Q

What extra test in post pregnancy fissure

A

Anal manometry - don’t want to do normal things for this if low sphincter tone - do sitz bath, fiber, hydration – no dilt ointment, botox or LIST
Do endoanal advancement flap

47
Q

Anti-fast bacilli and breast granulomas? dx and tx?

A

Granulomatous mastitis
tx - steroids

48
Q

what breast lesions grow with pregnancy

A

Fibroadenoma and fibrocystic disease

49
Q

What normal breast ca staging tests can you not do in pregnancy

What do you do instead

A

Typically PET CT CAP and bone scan - but in pregnancy you do chest xray and liver US

50
Q

2nd trimester breast ca

A

Consult high risk ob
No breast conservation - can’t do radiation
Rec: mastectomy and SLNBx with radioactive tracer (no blue dye)
If trip negative – adjuvant chemothearpy

Breast conservation contraindicated in 1st / 2nd trimester – safe answer is mastectomy

If positive SLNBx – do ax node dissection because you can’t receive radiation

Chemo can be given during pregnancy so neoadjuvant chemo can be used to push back the timing of radiation

51
Q

What is 2nd trimester

A

Weeks 13 - 28

52
Q

Who can not get breast conservation

A

Prior radiation
1st or 2nd trimester
Collagen vascular disease
Widespread microcalcs

53
Q

Who needs staging with breast CA

A

Inflammatory
Locally advanced
Chest wall recurrence following mastectomy

54
Q

Labs for milky discharge

A

endocrine - prolactin, bmp, thyroid, pregnancy

54
Q

What if no enlarged parathyroid seen on US

A

Sestamibi scan or 4d CT scan
(sestamibi better for reoperative parathyroidectomy)
Negative imagig gets 4 gland exploration

54
Q

Lab test specific for Graves

A

Thyroglobulin stimulating assay
Thyroid stimulating ab

54
Q

What labs to track with methimazole

A

CBC - agranulocytosis
LFT - hepatotoxic
Free t3 / t4 hould normalize, but TSH will take time to increase to normal

55
Q

When to get thryoid scintigraphy

A

Single nodule in hyperthyroid patient – to r/o solitary toixc nodule
(Same as radioactive iodine scan)

Can treat with radioactive iodine or a lobectomy to remove the nodule
Dont biopsy a toxic nodule on US

Scintigraphy for graves – will show diffuse enlargement and uptake

56
Q

WHen can you not do radioactive iodine for graves

A

If there is eye symptoms they can worsen with radioactive iodine

57
Q

Benefit of total thyroid in papillary thyroid ca

A

Allows post op radioactive iodine for additional treatment
Can use predictive models to determine risk from tumor factors to determine benefit of total thyroid

58
Q

Who gets total thyroid for papillary ca

A

> 4cm
Extrathyroid extension
Metastatic ln on US or thyroidectomy
BL nodules
History of prior hypothyroidism

59
Q

Tx for papillary thryoid with positive LN

A

If positive FNA of node – total thyroid and ipsilateral central and lateral neck dissection (if node is lateral)
Do a CT w/ IV to assess lymphadenopathy pre-op

Can biopsy suspicious node in OR and send frozen - if positive, central neck dissection and total thyroid

60
Q

Order for steps for indeterminate thyroid lesion

A

thryoid labs
US - indeterminate
FNA - Indeterminate

Can repeat FNA and perform molecular testing vs doing lobectomy vs repeat US in 3 months with repeat FNA

If molecular is positive – do a dx lobectomy – and if it is positive for

61
Q

Treatment after lobectomy for papillary thyroid ca with 2cm and no extension or nodes

A

no additional treatement
check thyroid funciton 6 weeks out
US in 6 months and annually

62
Q

Labs for adrenal

A

CBC, CMP, 1 mg low dexameth, dhea, acth, renin, aldosterone and plasma metanephrines

63
Q

Labs for post op hypocortisol

A

Hyponatremia, hyperkalemia, tachy hypotensive

64
Q

High risk for post adrenal ca mets

A

mitotic rate
high ki 67

recommend serial imaging every 3-6 months with ct cap

65
Q

Hyperaldosterone things

A

htn, hypokalemia, resistant bp – check serum aldo, plasma renin and bmp

66
Q

Medical treatment for hyperaldos

A

spironolactone

67
Q

After elevating liver in right side adrenal what next

A

continue medially until you get to lateral side of the IVC - identify the vein by identifying the renal vein and going superior

68
Q

Meds for treatment of BL adrenal cortisol hyperplasia

A

mifepriostone, ketoconazole and mitriapone

69
Q

Labs for MEN

A

calcitonin, cea, calcium, pth and plasma metanephrines

70
Q

Imaging for MEN 2

A

CTCAP and Cervical US

After surgery monitor cea and calcitonin levels

71
Q

Any LN positivity in melanoma needs–

A

staging with CT and PET CAP

MSLT 2 - if small foci in 1 node and no extracapsular invasion can elect for close observation with mri and us

72
Q

How to determine LN basin in melanoma

A

SPECT CT lymphosyntygraphy

73
Q

Follow up melanoma

A

H/p 3-6 months
Groin US q4 months for 2 years, then annual
Annual PET CT

74
Q

Imaging for Serous Cyst adenoma

A

benign older females
microcystic honeycomb with stellate scar and no duct connection
low cea and amylase in fna sample

75
Q

Mucinous cyst adenoma characteristics

A

premalignant
4-5th decade female
large macrocytic in body or tail
Peripheal calcs
high cea low amylase

76
Q

IPMN

A

communicates with main duct
high cea high amylase

77
Q

Surveillance after IPMN

A

if high grade dysplasia – semi annual EUS and MRI alternating

78
Q

Best way to assess for pancreatic cancer

A

if resectable then resect
if borderline then do EUS with FNA – better than ERCP brushings
BUt you need to put stent if hyperbili and getting upfront neoadjuvant therapy
Get ca 19 9 after decompressing biliary system

79
Q

Hyperdense pancreative lesion on arterial phase?

A

Think neuroendocrine tumor

need grade and differentiation in pNETs

80
Q

Sensitive test for metastatic pNET

A

Dotatate Pet CT – well differentiated will light up on this
remove any functional pNET

81
Q

how to rule out functional pNET

A

fasting gastrin / insulin / glucose levels

asymptomatic pNET get removed at 2 cm size or fast growth

82
Q

what abx to include if salt water or fish ingestion

A

Doxy for VV

83
Q

Big steps of code

A
  • Big Steps
    o Initiate chest compressions
    o Establish IV access
    o Ensure good airway
    o Work through ABCs
    o End tidal over 10, 100 – 120 compressions / minute with 2 cm of chest wall movement allowing for recoil
  • ACLS Algorithm
    o Epi 1 mg IV given every 3-5 mins
    o Pulse check every 2 minutes
    o Other drugs that are included
     Calcium
     Magnesium
     Amiodarone
     Lidocaine

connect AED
intubate if can’t bag mask

84
Q

is pea a shockable rhythm

A

no pea is a non shockable rhythm

85
Q

Reversible causes of coding

A

Hypovolemia
Hypoxia
Hypercarbia
Hypothermia
Hypo/hyperkalemia

Tension pneumo
Tamponade
Thrombosis – pulm or cardiac
Toxins

86
Q

2 shockable rhythms?

A

V tach and V fib

87
Q

V fib or v tach – which is synchronized

A

V tach you shock synchronized defibrillation

V fib is unsynchronized shock

88
Q
A

Last Minute Oral Boards (3 decks)

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